May 30, 2019

expert reaction to royal college of psychiatrists position statement on antidepressants

Reactions to new Royal College of Psychiatrists position statement on antidepressants. 

Prof David Nutt, The Edmond J Safra Chair and Head of the Centre for Neuropsychopharmacology, Division of Brain Sciences, Dept of Medicine, Imperial College London, Imperial College London, said:

“Through all my 40 years of psychiatric practice I have faced attacks on antidepressants. The current one relating to withdrawal was effectively examined by prior in-depth investigations including the by the Committee on Safe Medicines in 2005 and is succinctly summarized in the latest Journal of Psychopharmacology editorial SSRI withdrawal.

“Behind these attacks lie a series of false beliefs such as 1. Depression isn’t an illness so doesn’t warrant medical interventions 2. Talking therapies are as or more effective than antidepressants 3. Such therapy is free of adverse effects. The error of each of these beliefs, and the drivers for them, have been well described in two short papers”

https://journals.sagepub.com/doi/pdf/10.1177/0269881108091877

Prof Allan Young, Professor of Mood Disorders, Institute of Psychiatry Psychology & Neuroscience, King’s College London (IoPPN), said:

“Major depression is a common and frequently severe disorder which if untreated may cause great suffering and early death. Antidepressants are thoroughly evaluated medicines which have proven benefits over many years. However, all treatments should be scrutinised on an ongoing basis for evidence of harm and any judgement of such harms should be based in the context of the quality of the evidence gathered. All treatments, not just antidepressants, should be considered in the round for evidence of benefits and harms and clinical practise should be based on good science.

“Antidepressants, like all drugs, should be taken as per best advice. So called withdrawal reactions are usually mild to moderate and respond well to simple management. Anxiety about this should not obscure the real benefits of this type of treatment.”

Prof John Geddes, Professor of Epidemiological Psychiatry and Head of the Department of Psychiatry, University of Oxford, said:

“This initiative by the Royal College of Psychiatrists is timely because there currently a great deal of discussion and uncertainty across social media, conventional media and in the scientific literature about withdrawal symptoms from antidepressants. As clinicians, it’s important that we make sure patients are aware of the evidence we have on antidepressant withdrawal.  And it’s important that NICE conduct a robust and thorough assessment of all the available evidence to understand the incidence and clinical implications of the distressing and sometimes devastating adverse effects that some patients report when coming off antidepressants. This is a top priority in our own research agenda and we are in the process of collecting data not only from studies conducted by the pharmaceutical industry, but also from population registries and survey with people with lived experience of depression and antidepressants.”

A NICE spokesperson said:

“NICE welcomes today’s position statement on antidepressants and depression from the Royal College of Psychiatrists.

“Ensuring patients can safely discontinue using antidepressants, when they are no longer clinically required, is a topic which requires careful investigation because there is limited high quality data in this area.

“We are currently updating our guideline on the diagnosis and management of depression in adults. As part of that work and following public consultation on an initial draft guideline last year, the independent guideline committee has now looked at the most up-to-date evidence on managing the symptoms that can occur when people stop taking their antidepressant medication.

“A consultation on this document is due to begin later this year. We hope the final guideline will allow people with depression to be offered the best treatments and reach joint decisions about their care that reflect their preferences and values.

“NICE is also developing a guideline on the safe prescribing and withdrawal of prescribed drugs. A consultation on the proposed scope of this guideline will also begin in the summer.”

The Royal College of Psychiatrists published their position statement on antidepressants on Thursday 30 May 2019

Declared interests

Prof Allan Young:

Employed by King’s College London; Honorary Consultant SLaM (NHS UK)

Paid lectures and advisory boards for the following companies with drugs used in affective and related disorders:

Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics 

Consultant to Johnson & Johnson

Consultant to Livanova

Received honoraria for attending advisory boards and presenting talks at meetings organised by LivaNova.  Principle Investigator in the Restore-Life VNS registry study funded by LivaNova.

No share holdings in pharmaceutical companies

Lead Investigator for Embolden Study (AZ), BCI Neuroplasticity study and Aripiprazole Mania Study

Investigator initiated studies from AZ, Eli Lilly, Lundbeck, Wyeth, Janssen

Grant funding (past and present): NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK). Janssen (UK)

Prof John Geddes: No COI

None others received.